Healthcare Provider Details

I. General information

NPI: 1356259410
Provider Name (Legal Business Name): ALEXA ZAMUDIO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4339 DI PAOLO CTR
GLENVIEW IL
60025-5202
US

IV. Provider business mailing address

1847 MAPLE AVE
BERWYN IL
60402-1549
US

V. Phone/Fax

Practice location:
  • Phone: 847-299-1920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.308769
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: